H5N1

Angola & DRC: MSF teams help curb yellow fever

Via MSF.org: Angola & DRC: MSF teams help curb yellow fever. Excerpt:

In the DRC, MSF is vaccinating the entire population of the city of Matadi, while treatment and yellow fever vector control activities (destruction of mosquito) are under way in Kinshasa and in Kongo Central province. In Angola, MSF is supporting the Ministry of Health in treating patients. 

Following the outbreak of yellow fever in Angola in December and the subsequent confirmation of dozens of cases in the DRC, MSF teams were deployed in both countries to help contain the spread of the disease. On May 19, the World Health Organization found that the outbreak, though serious and of grave concern, does not currently constitute a public health emergency of international concern. 

Deploying the highly effective yellow fever vaccine is key to prevent further spread, and the limited supply of the vaccine must be used efficiently. 

In the DRC, 48 cases have been confirmed since the end of February. The majority are among people arriving from Angola, but three indigenous cases (locally transmitted) were also identified in Kinshasa and in Kongo Central and Kwango provinces, on the Angolan border. 

In Matadi, the capital of Kongo Central, MSF teams on 26 May launched a vaccination campaign intended for its 350,000 residents, as part of the Congolese Ministry of Health (MoH) programme aimed at a target population of two million people. This single programme covers two health districts in Kinshasa and nine health districts in Kongo Central. 

Also in cooperation with the Health Ministry, MSF has launched vector control measures in Kinshasa and Kongo Central. These activities are intended to combat the Aedes aegypti mosquito, the carriers of yellow fever. Homes are being sprayed or fumigated to kill adult mosquitoes and teams are destroying breeding sites such as refuse or items containing stagnant water where mosquitoes lay its eggs. These activities are being carried out in locations where cases have been confirmed and in vulnerable locations such as hospitals, schools and markets. 

MSF is also treating patients, providing medical supplies to identified health centres and training staff in yellow fever treatment. 

“To eliminate any risk of the disease spreading, it is vital to be vigilant and responsive,” says Elisabetta Maria Faga, MSF emergency coordinator. “There is no specific treatment for yellow fever. Prevention through targeted vaccination and vector control measures therefore remains the best weapon against the disease.”

CIDRAP: WHO cites Zika funding gap, rejects call to move Olympics

Via CIDRAP, Lisa Schnirring writes: WHO cites Zika funding gap, rejects call to move Olympics. Excerpt and then a comment:

In new Zika virus developments over the past few days, the World Health Organization (WHO) issued a response update showing a large funding gap, rejected a call to lobby for relocation or postponement of the Olympic games in Brazil, and expanded the recommended safe-sex or abstinence period for men who visit affected areas. 

In another development, the US Centers for Disease Control and Prevention (CDC) today updated its guidance on Zika antibody testing to address difficulties in weeding out cross-reactions from related viruses. 

Response funding falls far short 

The WHO spelled out details of the funding gap in a May 27 interim report on the global response to the Zika virus outbreak since the February launch of its strategy framework, which has involved 23 health partners. 

In its original plan, the WHO and its collaborators requested $56 million to fund the first 6 months of the response, with the total amount needed outstripping that amount. The WHO said it quickly released $3.8 million from an emergency contingency fund that was established in May 2015 as part of reforms in the wake of West Africa's Ebola outbreak. It added that plans include reimbursing the contingency fund. 

With funding falling far short of the need, the WHO said requirements have been reprioritized into essential activities to ensure that the limited support is funneled to where it is needed most.

Sometime later this century, someone will write a history of WHO and global-health disasters, and will point out that an agency whose funding hadn't really been increased since the 1970s was not likely to deal effectively with outbreaks. Moreover, this historian will say, governments that refused to spend more on fighting global-health outbreaks didn't deserve to survive, and indeed did not.

US: First baby infected with Zika virus born in New York City area

Thanks to Lucie Lecomte for sending the link to this report in The New York Post: First baby infected with Zika virus born in NYC area. Excerpt:

A baby with a Zika virus-linked birth defect was born for the first time in the New York City area Tuesday, according to a reports. 

The baby girl, who has not been named, was born in New Jersey with a partially developed brain due to the virus, according to FoxNews.com. 

The infant’s 31-year-old mom contracted the mosquito-transmitted virus while in Honduras, doctors at Hackensack University Medical Center in New Jersey told the website. The unnamed mom checked into the emergency room of the hospital with a rash while vacationing in the U.S. Friday, doctors said. 

She developed a rash for two days in Honduras — but had no other Zika symptoms until she arrived in America, doctors said. 

She was devastated by her child’s condition, according to Fox.

US: Texas announces first locally acquired chikungunya case

Via the Texas Department of State Health Services: DSHS Announces First Texas-Acquired Chikungunya Case. Excerpt:

The Texas Department of State Health Services has confirmed the first locally acquired case of chikungunya, a mosquito borne illness. A Cameron County resident got sick with the illness in November 2015 and was diagnosed with a lab test in January 2016. 

The case, however, was not reported to the local health department until last month. The investigation performed by the Cameron County Department of Health and Human Services determined the patient had not traveled, and the case was confirmed last week by testing at the US Centers for Disease Control and Prevention. 

Chikungunya disease is a viral illness spread by mosquitoes and was first detected in travelers returning to Texas from areas with local transmission in 2014. All previous Texas residents who contracted the illness were infected while traveling abroad. Because this case was contracted more than six months ago and mosquito surveillance has not found chikungunya in local mosquitoes, the primary risk of infection remains related to travel. DSHS encourages people to protect themselves from mosquito bites at home and while traveling to stop the spread of chikungunya, Zika and West Nile virus. 

Chikungunya and most other viruses transmitted by mosquitoes are required to be reported to the local health department or DSHS regional office within one week. DSHS reminds laboratories and health care providers to report cases promptly so health officials will have the information they need to make decisions that will protect public health.

ECDC: More on the RRA update of yellow fever

ECDC has published a news release: The risk of international spread of yellow fever is re-assessed in light of the ongoing outbreak in Angola, DRC and Uganda. Click or tap through for links and to download the latest rapid risk assessment.

ECDC has updated its rapid risk assessment on the outbreak of yellow fever with the latest developments, more comprehensive information on the current situation in Angola, Democratic Republic of Congo (DRC) and Uganda and an extended threat assessment for the EU. Some of the data used in the assessment were collected during a mission to Angola in May 2016.   

Current situation 

From 21 January to 22 May 2016, the Angolan Ministry of Health notified 2 536 yellow fever cases, of which 747 were confirmed and 301 fatal. The number of new suspected and confirmed cases in Angola has been decreasing and a mass vaccination campaign has already reached about half of the targeted population. 

However, the outbreak in Angola is not yet under control and is currently expanding to additional provinces, further challenging the ongoing mass vaccination campaign. Currently, all regions in Angola should be considered as areas at high risk of transmission of yellow fever.   

The yellow fever outbreak in Uganda is unrelated to the outbreak in Angola. Between 26 March and 19 May 2016, health authorities reported 60 yellow fever cases, including seven deaths in six different districts.  

As of 23 May, DRC has reported 590 cases of yellow fever, 41 of these had a recent travel history to Angola.   

Viraemic patients travelling to areas where suitable vectors and susceptible human populations are present pose a risk for local transmission. Such areas exist in most of the inter-tropical zones of Africa, and the Americas and Asia. Therefore, the risk of international spread within Africa and beyond is currently high.   

ECDC threat assessment for the EU  

In the EU/EEA, the risk of yellow fever virus being introduced is limited to unvaccinated viraemic travellers coming from areas with active local transmission. Given that outbreaks of yellow fever in urban settings have the potential for rapid spread and that significant yellow fever epidemics are ongoing in Angola, DRC and Uganda, a range of options for response by EU/EEA Member States are presented in the updated rapid risk assessment. These options emphasize the importance of vaccination of travellers and those leaving Angola, preventive measures against mosquito bites in affected areas, as well as awareness raising among clinicians to consider this diagnosis in returning travellers.

The clinical spectrum of Zika virus in returning travelers

Thanks to Greg Folkers for sending the link to this report in The American Journal of Medicine: The clinical spectrum of Zika virus in returning travelers. The abstract:

Introduction 

The clinical spectrum of Zika virus (Zika virus) had to date been described in small series from endemic/epidemic countries and is not well established. 

Methods 

We describe the clinical manifestations of laboratory-proven Zika virus infection in Israeli travelers during 12/2015-02/2016, and review all published cases of travel-related Zika virus. 

Results 

During the study period eight returning Israeli travelers were diagnosed with Zika virus infection. In addition, 41 published cases were included, mostly from Latin America to Europe and North America. Overall, 65.3% were diagnosed by PCR. Rash was the most frequent symptom, present in 95.7% of cases, followed by fever and arthralgia. Conjunctivitis was present in 53.1%, however only 40.3% presented with a triad of conjunctivitis, fever and rash. Less frequent symptoms included dysgeusia [distortion of the sense of taste] and nightmares, which together with arthralgia persisted for several weeks in some travelers. 

Conclusions 

Zika virus clinical picture in travelers is diverse. Prolonged symptoms may occur.

Puerto Rico’s tourism industry feels economic sting of Zika

Via Caribbean Business: Puerto Rico’s Tourism Industry Feels Economic Sting of Zika. Excerpt:

It was the wedding of one of her best friends, and Natalie Kao was going to be a bridesmaid in a fun, tropical setting on a small island just off the east coast of Puerto Rico. But the prevalence of the Zika virus across the U.S. territory gave her pause. 

Kao, pregnant with twins, knew the mosquito-borne Zika virus has been linked to a rare birth defect in a tiny percentage of cases. But even a small risk was too great. “You don’t know the impact, which is very scary,” the San Francisco woman said. 

She sent her regrets, as did several dozen other members of the wedding party. 

Puerto Rico has been hit harder by Zika than any other part of the U.S., with more than 1,170 confirmed cases, one death and the first microcephaly case acquired on U.S. soil. Now, worries about the virus are starting to affect the tourism industry, which had been one of the few bright spots in an otherwise dismal economy. 

The full number of people who have canceled plans to visit or chose another destination is unknowable. But people have cited Zika in the cancellation of at least 42,000 hotel room reservations through 2018, which translates to about $28 million in lost revenue for the lodging, restaurant and tour industry, said Ingrid Rivera, executive director of Puerto Rico’s Tourism Company. 

People who work in the industry say they have been seeing the financial effects of Zika for months, and it appears to be getting worse. 

“Cancellations left and right and up and down,” said Luis Alvarez Perez, owner of a luxury travel planning and relocation company in San Juan. “People just stopped coming.”

Syria: Cutaneous leishmaniasis sweeping Middle East

Via The Independent: Cutaneous leishmaniasis: What is the tropical disease eating its way through Syria and can it be stopped? Excerpt:

A tropical parasitic disease causing serious disfiguration is sweeping across the Middle East. Cutaneous leishmaniasis has been common in Syria for centuries but recent social unrest and breakdown in the healthcare system have seen it develop into a major epidemic. 

The disease is identifiable through vast sores on the skin, which can be both painful and permanently disfiguring. 

Research has revealed hundreds of thousands of people are now suffering from the condition in refugee camps or trapped in conflict zones. It is thought close proximity caused by cramped conditions is facilitating the disease’s spread, compounded by lack of healthcare structures due to civil unrest and societal breakdown amid the on-going conflict and mass displacement. 

What is it? 

Also known as 'aleppo evil', cutaneous leishmaniasis is a tropical disease caused by a parasite in the blood stream. It is transmitted from person to person through sand fly bites, which are common in the Middle East. 

Other forms exist with varying severity. Visceral leishmaniasis is the most severe form and results in fever, as well as enlargement of the liver and spleen. It can be fatal if left untreated. Mucocutaneous leishmaniasis eats away at the membranes of the nose, mouth and throat. 

Where is it? 

Scientists have warned it is multiplying rapidly in Syria with hundreds of thousands of cases suspected. In Lebanon, there were six reported cases between 2000 and 2012, by comparison 1,033 cases were reported in 2013 alone. 

Cases have also been reported in Turkey, Jordan, Eastern Libya and Yemen.  

What does it do? 

It causes large open sores on the skin. The sores are painful and often lead to permanent disfiguration. The sores are also vulnerable to secondary infection, spreading further disease.

Why is it spreading now? 

Previously the disease has been largely contained to Syria. However, amid societal breakdown due to conflict there, it has increased. Lack of healthcare resources means the condition has not been treated and as people have become trapped in conflict zones they have increased in close contact with other people, further spreading the disease. Poverty and malnutrition, as well as lack of access to clean water, may be further exasperating the situation. 

It appears to have spread outside of Syria partly due to refugees fleeing the area. Refugee camps often involve living in close quarters with strangers, without medical treatment facilities beyond those which can provide emergency or basic care.

Brazil and Colombia create Office of Coordination to fight Aedes aegypti

Via the Brazilian Ministry of Health: Brasil e Colômbia criam Sala de Coordenação do combate ao Aedes aegypti.[Brazil and Colombia create Office of Coordination to fight Aedes aegypti] Edited excerpt from the Google translation:

Two municipalities located in the border region between Brazil and Colombia gained another reinforcement in combating Aedes aegypti, which transmits dengue, chikungunya and Zika virus. Tabatinga and Leticia will have a Binational Office of Coordination to Control Aedes. The joint action will allow the two municipalities to share epidemiological information and perform common strategies to tackle the mosquito. The office will support the National Coordination and Control Office (SNCC).

The Binational Office will start meetings in June and will include three representatives from each city. The Department of Health in the Brazilian city of Tabatinga donated the physical space and the Foundation of Health Surveillance of the Amazon (FVS - AM) has donated equipment such as computers, freezer and refrigerator for storage of samples. The meetings will take place in Tabatinga, always on the last Friday of each month.

The goal of both countries is to replicate successful actions to combat the mosquito, such as the Brigades against Aedes where health surveillance teams train representatives of civil society, students, employees of public and private companies, churches and community associations on mosquito life cycle, characteristics of breeding in the region and prevention methods. 

"Those who are trained replicate what they learn in their institutions or communities, thus becoming multipliers of good practice", said Bernardino Albuquerque, coordinator of the State of the Amazon Office.

Migrant smuggling is a $6-billion business and it’s getting worse

Via The Globe and Mail: Migrant smuggling is a $6-billion business and it’s getting worse. Excerpt:

Who are the smugglers? 

Security officials believe 90 per cent of all human smuggling to Europe takes place with the help of criminal groups. That percentage is expected to increase as the lucrative smuggling routes draws more criminal elements looking to make a profit. 

The smugglers are part of a multinational network – and they are as diverse as the very people fleeing conflict, persecution and economic crisis: Smugglers belong to 100 nationalities, often sharing the same country origins as those desperate to get to Europe. 

Smugglers are no strangers to criminal activity – and the increasing demand for their services is drawing those already involved with other areas of crime, including drug trafficking, property crime and document forging. 

Smuggling networks have a loose structure: Leaders who co-ordinate and control activities along the main routes; organizers who take charge in towns and cities where migrants are transiting and staying; and low-level facilitators that include drivers, scouts and recruiters who promise safe passage for the right price. 

Libya’s coastline is where thousands put their lives in the hands of smugglers. Libyan smugglers keep migrants in safe houses for days and weeks at a time. Migrants, often suffering from health problems from their journey through the Sahara, have little access to medical aid or food. Some are physically abused. 

Fishing boats bought by smugglers set off from coastal towns such as Zuwara in early hours of the morning. Those who steer the fishing boats can be incompetent. The sinking of a boat off Libya last April that killed more than 800 people happened in part because the Tunisian captain mistakenly rammed a merchant ship that was attempting to assist them.